A federal judge has already blocked similar programs in Arkansas, Kentucky and New Hampshire.
Andrea Young, a 54-year-old woman who lives in Michigan, works two part-time jobs while completing her bachelor’s degree in sociology. Her working hours vary week to week: In addition to being on call at a residential care facility for the elderly and disabled, she also works as a library assistant at her community college as part of a work-study program.
Young’s options for employment are limited, according to a lawsuit she and three other Michiganders filed last month. Not only does she have to rely on public transportation to get to work and school, but she also has severe pain associated with an injury sustained at the last place she worked, a Chrysler plant.
Medicaid coverage gives Young the tools she needs to feel well enough to go to work and school. Under the Healthy Michigan Plan (the state’s Medicaid expansion program), Young is able to obtain the medications she needs to manage her pain and inflammation, and attend weekly physical therapy.
Next year, however, a new state law set to go into effect threatens Young’s health coverage—and that of thousands of other Medicaid recipients.
Starting in January, Medicaid recipients will be required to report 80 hours of work or other activities (such as job training, searching for a job, or volunteering) a month to the Michigan Department of Health and Human Services. (The law also requires certain recipients pay 5 percent of their income in premiums, though that and so-called “healthy behavior” assessments have been put on hold till October 2020.)
After being notified that they would have to comply with the new work requirements, four Michigan residents, including Young, sued the U.S. Department of Health and Human Services (HHS) to challenge the Trump administration’s approval for the waiver that gave the state the go-ahead to make work requirements a condition of Medicaid coverage. As the class-action lawsuit states, the federal government’s actions threaten “irreparable harm to the health and welfare of the poorest and most vulnerable in our country.”
Similar legal challenges have also been filed in four other states: Kentucky, Arkansas, New Hampshire, and Indiana. Earlier this year, a federal judge blocked Medicaid work requirements in Arkansas and Kentucky, as well as in New Hampshire. Advocates are currently awaiting a decision, which could come down any day now, from the U.S. Court of Appeals for the District of Columbia for the cases involving Kentucky and Arkansas.
The plaintiffs in the Michigan suit are represented by the Michigan Center for Civil Justice, the Michigan Poverty Law Program, and the National Health Law Program. According to the complaint filed Nov. 22, HHS does not have the legal authority to waive provisions in the Medicaid Act to implement work requirements because they do not promote the law’s original intent, which is to support people “whose income and resources are insufficient to meet the costs of necessary medical services.”
Between 61,000 and 183,000 people in Michigan who obtain care through the Healthy Michigan Plan are expected to lose coverage in one year due to work requirements, according to a report published earlier this year.
Another recent study from the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital in Boston found that Medicaid work requirements in Arkansas—the only state where the work requirements program had the opportunity to go live—were associated with “a significant loss of Medicaid coverage and rise in the percentage of uninsured persons.”
Researchers also found “no significant changes in employment associated with the policy,” the paper states, because nearly all Medicaid beneficiaries in Arkansas targeted by work requirements “already met the requirement or should have been exempt.”
Those findings and other studies contradict what proponents of Medicaid work requirements, such as Centers for Medicare & Medicaid Services Administrator Seema Verma, often say. For example, in a speech last month to the National Association of Medicaid Directors, Verna suggested that in order to improve health outcomes, it’s important to get people who are on public assistance working to have “a life infused with meaning and purpose … that is, a life that knows the dignity of a job.”
She added: “A Medicaid program that locks people into poverty begins to look less like a safety net and more like a trap.”
“You don’t force people to work to get them healthy. You enable them to be healthy, which enables them to work.”
Leonardo Cuello is the director of health policy at the National Health Law Program. In an interview with COURIER, he pointed out: “You don’t force people to work to get them healthy. You enable them to be healthy, which enables them to work. That’s like saying the rain causes clouds.”
Proponents of these requirements, such as the legislation’s primary sponsor Senate Majority Leader Mike Shirkey (R-Clarklake), also point out that “the most vulnerable populations served by Medicaid” will be exempt, including pregnant mothers, people with disabilities, students, and caretakers.
“They sell it as something that will have a very narrow impact, but the reality is, in fact, the impact will be much broader than that,” Cuello said. “Even if it were OK to terminate someone’s health insurance for not working—which it’s not—this terminates tons more people than that.”
One problem, he explained, includes the logistics of reporting. “If you have a population of 200,000 adults in the Medicaid program, and what you’re trying to do every single month is confirm that they worked so that they meet their monthly work requirement, that means you have to be in touch with 200,000 people in real time every month. That just isn’t possible.”
In fact, reporting how many hours she works each month is a concern for Young, one of the plaintiffs in the lawsuit. According to the complaint, her Medicaid coverage has been terminated twice in the past because she did not receive notices from DHHS. When she went to her local health department to find out why, she discovered she didn’t receive requests for additional information “because the notices did not include her apartment number on the address.”
Last week, Gov. Gretchen Whitmer called for lawmakers to suspend—as Arizona and Indiana has—the work requirements set to go into effect soon, citing the pending litigation. Previously, the Democratic governor has called the provision “the most onerous … in the nation.”
In a joint statement, Senate Majority Leader Shirkey and House Speaker Lee Chatfield (R-Levering) said they had no plans to pause the program.
“Able-bodied adults who want cash assistance and subsidized healthcare coverage should obviously be expected to either work part time or at least prepare for a career in exchange for welfare benefits,” they said in the statement. “That is simply common sense, and it is something the Michigan taxpayers who foot the bill for these programs expect.”